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CERTIFICATE OF LIABILITY INSURANCE (155)'4 °® CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDIYYYY) 6/12/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Adcock - Adcock Property & Casualty Agency, Inc. 315 W. Fletcher Ave. Tampa FL 33612 -3414 CONTACT Radha Jones NAME: la/c°NN .Extt: (813) 933 -6691 A/C. No): (813)932 -6287 ADDRESS: radhaj@adcock-insurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Southern- Owners Insurance Co. 10190 INSURED CGM Services Inc 1015 E Martin Luther King Blvd Tampa FL 33603 INSURERB:PraetOrian Insurance Company 37257 INSURERC:St. Paul Fire & Marine 24767 INSURERD:Bridgefield Employers Ins Co 10701 INSURER E : $ 50,000 INSURER F: $ 10,000 COVERAGE CERTIFICATE NUMBER:CL1361206153 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYY) POLICY EXP (MM/DDYYYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 20337426 (% j) " 1/17/2013 1/17/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 GE X 'L AGGREGATE LIMIT APPLIES PER: POLICY n IFCT II LOC $ B AUTOMOBILE _ X X — LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS ,.-. ay" 1 , P090000(p2`8 a6...- `` 6 L77-7':.:12:L , y ` a 12, 20il13 �! / t 6/12/2014 / COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ PIP -Basic $ 10,000 `., X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE ZUP- 14R76158 -13 -NF 6/12/2013 1/17/2014 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED I X RETENTIONS 10,000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N/A 0830 -43595 1 1/1/2013 1 / 1/1/2014 I ( X TORY LIAMITS OT I I E.L. EACH ACCIDENT $ 1, 000, 000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 $ 1,000,000 E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Clearwater 100 S Myrtle Clearwater, FL 33756 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Jeffrey Kemp, CIC /RRJ 1 ACORD 25 (2010/05) INS025 (201005).01 © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD